Journal of Plastic Reconstructive and Aesthetic Surgery最新文献

{"title":"Technique refinement for complex locoregional reconstruction after spine surgery: Optimization of closed suction drain use","authors":"Nikhil Sobti ,&nbsp;Carole S.L. Spake ,&nbsp;Daniel Hu ,&nbsp;Elijah Persad-Paisley ,&nbsp;Vinay Rao ,&nbsp;Victor King ,&nbsp;Rahul Sastry ,&nbsp;Adetokunbo Oyelese ,&nbsp;Ziya Gokaslan ,&nbsp;Daniel Kwan ,&nbsp;Paul Y. Liu ,&nbsp;Albert S. Woo","doi":"10.1016/j.bjps.2025.01.073","DOIUrl":"10.1016/j.bjps.2025.01.073","url":null,"abstract":"<div><h3>Introduction</h3><div>Plastic surgeons have become increasingly involved in the locoregional closure of spinal wounds after instrumentation, which has proven to minimize postoperative complications, especially among high-risk patient populations. Therefore, optimization and standardization of surgical techniques, including drain placement, for complex spine closure remain paramount. This study aims to investigate drain usage after plastic surgery closure for spine wounds to identify risk factors for postoperative complications that may provide insight to further guide intraoperative decision making.</div></div><div><h3>Methods</h3><div>An IRB-approved retrospective chart review was conducted to identify 174 consecutive patients who underwent spinal instrumentation with plastic surgery-assisted locoregional flap closure performed at a tertiary academic medical center between January 2016 and July 2021.</div></div><div><h3>Results</h3><div>Patients who underwent locoregional complex closure of spinal wounds with a single drain (n = 89) demonstrated a lower incidence of infection (4.5% versus 16.5%, <em>p</em> = 0.01) and wound dehiscence (1.1% versus 9.4%, <em>p</em> = 0.02) when compared with the multidrain cohort (n = 85) via univariate and binomial regression analysis. The depth of infection (superficial versus deep) did not vary between groups. Seroma rates were comparable (13.5% versus 15.3%, <em>p</em> = 0.76). Longer time interval to drain removal (&gt;3 weeks) was found to increase the risk of infection.</div></div><div><h3>Conclusion</h3><div>Our results suggest that the use of multiple drains after locoregional closure of spinal wounds may confer an increased risk of surgical site infection, without theorized protection from seroma formation. In addition, the duration of drain placement should be used to guide the timing of drain removal, instead of daily output.</div></div>","PeriodicalId":50084,"journal":{"name":"Journal of Plastic Reconstructive and Aesthetic Surgery","volume":"103 ","pages":"Pages 148-156"},"PeriodicalIF":2.0,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143445102","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors contributing to patient-reported satisfaction with breast augmentation six months postoperatively","authors":"Kim_Phi Luong ,&nbsp;Harm P. Slijper ,&nbsp;Laura Zaal ,&nbsp;Stefan Hummelink ,&nbsp;Dietmar J.O. Ulrich","doi":"10.1016/j.bjps.2025.01.074","DOIUrl":"10.1016/j.bjps.2025.01.074","url":null,"abstract":"<div><h3>Background</h3><div>Breast augmentation continues to be a popular procedure with high outcome satisfaction; however, dissatisfied patients still remain. To understand this outcome variability, this study aimed to identify factors that may influence satisfaction with the breasts postoperatively.</div></div><div><h3>Methods</h3><div>Primary breast augmentation patients were included in a multicenter observational cohort study (2016–2021). The primary outcome was satisfaction with breasts six months postoperatively measured using the BREAST-Q. Hierarchical multivariable regression analyses were performed in six steps including 1) patient characteristics, 2) preoperative anatomical breast characteristics, 3) implant characteristics and technique, 4) preoperative BREAST-Q scores, 5) postoperative anatomical breast characteristics, and 6) postoperative BREAST-Q scores. The final model included 27 determinants.</div></div><div><h3>Results</h3><div>For the analyses, 1058 patients were included. Patient characteristics, preoperative and postoperative anatomical breast characteristics, and preoperative BREAST-Q scores together could only explain 6% of the variance in satisfaction with breasts. After including the postoperative BREAST-Q scores, 34% could be explained. The final model showed that greater age, higher preoperative satisfaction with breasts, higher clinician visual analogue scale appearance, and higher postoperative psychosocial, physical, and sexual well-being were independently associated with greater satisfaction with breasts.</div></div><div><h3>Conclusion</h3><div>Although we included a comprehensive set of determinants, only small effects were found and most variance continued to be unexplained. Strikingly, patient, anatomical breast, and implant characteristics were of limited value in explaining the satisfaction with their breasts. Future studies should investigate which variables are important in explaining the remaining variance to fully comprehend the determinants of patient satisfaction.</div></div>","PeriodicalId":50084,"journal":{"name":"Journal of Plastic Reconstructive and Aesthetic Surgery","volume":"103 ","pages":"Pages 297-305"},"PeriodicalIF":2.0,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143552675","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Identifying key genes, miRNAs, and pathways in keloid formation: A bioinformatics and experimental study","authors":"Jiao Kong ,&nbsp;Changcai Zhou ,&nbsp;Haiyan Qin ,&nbsp;Caihong Li ,&nbsp;Zhuoxia Wu ,&nbsp;Lianbo Zhang","doi":"10.1016/j.bjps.2025.01.070","DOIUrl":"10.1016/j.bjps.2025.01.070","url":null,"abstract":"<div><div>Keloids represent a challenging clinical problem because of their unpredictable and often refractory nature to treatment. This study aimed to identify the key changes in gene expression in the formation of keloid and provide potential biomarker candidates for clinical treatment and drug target discovery. Keloids and normal skin samples were analyzed for gene expression, and datasets from the Gene Expression Omnibus database were also analyzed. Differentially expressed genes (DEGs) were identified and analyzed using bioinformatics techniques, including gene ontology and Kyoto Encyclopedia of Genes and Genomes pathway enrichment analyses. A protein–protein interaction network of the DEGs was created using the Search Tool for the Retrieval of Interacting Genes database. The gene set enrichment analysis was performed on keloid and normal skin tissue from clinical samples. The enriched functions and pathways identified included collagen-containing extracellular matrix (ECM), ECM, and external encapsulating structure. Ten hub genes were identified, along with one differentially expressed microRNA, miR-22–5p. miRNA target gene prediction was performed using miRPathDB 2.0 and Targetscan database. Among the hub genes, RUNX2, IGF1, EGF, and PPARGC1A were predicted targets of miR-22–5p. Validation at the tissue level highlighted RUNX2 as a crucial DEG in keloid tissue. These findings shed light on the molecular mechanisms of keloid formation and offer candidate therapeutic targets, suggesting that modulation of the miR-22–5p/RUNX2 axis may be a promising avenue for keloid diagnosis and treatment, thus laying a foundation for improved clinical management of keloid disorders.</div></div>","PeriodicalId":50084,"journal":{"name":"Journal of Plastic Reconstructive and Aesthetic Surgery","volume":"102 ","pages":"Pages 313-322"},"PeriodicalIF":2.0,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143394873","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reconstruction of cervical esophagus for hypopharyngeal or thyroid cancer with intractable leakage at the upper end of thoracic esophagus: A scoping review and the pedicled colon flap solution","authors":"Ying-Sheng Lin ,&nbsp;Hung-Chi Chen","doi":"10.1016/j.bjps.2025.01.079","DOIUrl":"10.1016/j.bjps.2025.01.079","url":null,"abstract":"<div><h3>Introduction</h3><div>Patients with advanced hypopharyngeal cancers or thyroid cancers often require pharyngoesophageal reconstruction after tumor ablation, but complications are frequent. Anastomotic leakage, particularly in patients receiving perioperative radiation therapy, poses a significant challenge. The aim of this study was to conduct a literature review on leakage management methods and present a novel approach: utilizing a pedicled colon flap to create a diverted conduit connected to the cervical neo-esophagus.</div></div><div><h3>Patients and methods</h3><div>A scoping review was conducted in March 2024. Additionally, between 2004 and 2022, 17 patients underwent pedicled colon transposition to the newly reconstructed cervical neo-esophagus. Four had neoadjuvant radiation therapy for thyroid or hypopharyngeal cancer, and the pedicled colon transposition method was used to prevent anastomotic leakage after hypopharyngeal reconstruction. The other 13 suffered leakage at the junction of the cervical neo-esophagus and thoracic esophagus after reconstruction. The method involved closing the cephalic end of the thoracic esophagus and using the pedicled colon transposition to restore alimentary tract continuity.</div></div><div><h3>Results</h3><div>The review identified 4 leakage prevention methods. In our clinical series, colon flap harvest averaged 4.5 h with no postoperative leakage observed. All patients resumed oral intake, but 65% experienced transient diarrhea that resolved within a month.</div></div><div><h3>Conclusion</h3><div>For patients who receive perioperative irradiation that complicates pharyngoesophageal reconstructions, a supercharged pedicled colon flap presents a feasible solution for managing anastomotic leakage.</div></div>","PeriodicalId":50084,"journal":{"name":"Journal of Plastic Reconstructive and Aesthetic Surgery","volume":"103 ","pages":"Pages 181-189"},"PeriodicalIF":2.0,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143479036","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Temporal rotation flaps for gender-affirming hairline feminization: Taking the “M” shape out of masculine hairlines","authors":"Graham C. Ives ,&nbsp;Alexander Martin ,&nbsp;Naikhoba C.O. Munabi ,&nbsp;James C. Lee ,&nbsp;Julie A. Ames ,&nbsp;Michael W. Chu ,&nbsp;David C. Kim ,&nbsp;Stacey H. Francis","doi":"10.1016/j.bjps.2025.01.054","DOIUrl":"10.1016/j.bjps.2025.01.054","url":null,"abstract":"<div><h3>Background</h3><div>In transfeminine patients seeking facial gender-affirming surgery, temporal recession of the hairline is a common feature that contributes to a masculine appearance. Standard central hairline advancement lowers the hairline without substantially improving hairline shape. In this article, we describe our technique utilizing bilateral rotational flaps of the temporal hair-bearing scalp to facilitate excision of the area of alopecia and compare outcomes of our technique to central hairline advancement alone.</div></div><div><h3>Methods</h3><div>This cohort study used data collected prospectively from patients who underwent facial feminization surgery in the Kaiser Permanente Southern California system. Intraoperative measurements of patients who underwent advancement of the central hairline only were compared to those of patients who underwent hairline advancement with temporal rotation flaps. Changes in the distance between 4 anatomic points were measured and compared between groups.</div></div><div><h3>Results</h3><div>A total of 86 patients were included. Twenty-four control patients who underwent central hairline advancement only were compared to 62 intervention patients who underwent temporal rotation flaps as well. Patients in the intervention group had greater improvement in the shape of their hairline as demonstrated by greater advancement of their temporal recession peak inferiorly and toward midline in the oblique (3.02 vs 1.31 cm; p &lt; 0.0001), lateral height (1.30 vs 2.11 cm; p &lt; 0.0001), and width (2.03 vs 0.15 cm; p &lt; 0.0001) measurements. There were no major complications.</div></div><div><h3>Conclusion</h3><div>The use of temporal rotation flaps in conjunction with a direct central hairline advancement procedure is a safe and effective method to feminize hairline shape in patients with temporal recession.</div></div>","PeriodicalId":50084,"journal":{"name":"Journal of Plastic Reconstructive and Aesthetic Surgery","volume":"102 ","pages":"Pages 404-411"},"PeriodicalIF":2.0,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143444434","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ultramicro skin grafting technique for the treatment of intractable linear scars using adjacent normal skin","authors":"Wenbo Wang ,&nbsp;Haiyang Liu ,&nbsp;Lingling Xia,&nbsp;Zongan Chen,&nbsp;Xiaoli Wu,&nbsp;Zhen Gao","doi":"10.1016/j.bjps.2025.01.078","DOIUrl":"10.1016/j.bjps.2025.01.078","url":null,"abstract":"<div><div>Intractable linear scars on the face, often resulting from trauma or surgery, pose significant clinical challenges due to their persistence and cosmetic impact. This retrospective study evaluated ultramicro skin grafting (UMSG) using adjacent normal skin in nine patients, with grafts harvested via a 0.6-mm micropunch and transplanted to scar sites. Over an average follow-up of 13.3 months, all patients achieved excellent repigmentation, social invisibility, and significant improvements in scar aesthetics based on the SCAR scale, without complications such as infections, hyperproliferation, or color mismatch. The minimally invasive nature, faster recovery, and favorable outcomes of UMSG suggest it as an effective and safe alternative for treating facial scars, warranting further validation through larger, controlled studies.</div></div>","PeriodicalId":50084,"journal":{"name":"Journal of Plastic Reconstructive and Aesthetic Surgery","volume":"102 ","pages":"Pages 225-227"},"PeriodicalIF":2.0,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143388514","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The application of multilayered three-dimensional costal cartilage framework in auricular reconstruction with expanded postauricular skin flap","authors":"Jianwen Qu ,&nbsp;Yang Yang ,&nbsp;Chuan Li ,&nbsp;Xiaobo Yu ,&nbsp;Jin Chang ,&nbsp;Lei Zhuo ,&nbsp;Bo Pan","doi":"10.1016/j.bjps.2025.01.069","DOIUrl":"10.1016/j.bjps.2025.01.069","url":null,"abstract":"<div><h3>Background</h3><div>This study introduces a construction method for a multilayered three-dimensional costal cartilage auricular framework and retrospectively analyzed its clinical effectiveness in auricular reconstruction with an expanded postauricular skin flap.</div></div><div><h3>Methods</h3><div>We designed multiple techniques for constructing a multilayered three-dimensional costal cartilage auricular framework to enhance stability and aesthetic outcomes. Postoperative follow-up included a comprehensive morphological assessment of the reconstructed ears, as well as evaluations of postoperative complications and patient satisfaction.</div></div><div><h3>Results</h3><div>The study collected data on 75 patients who underwent auricular reconstruction in our department between January 2021 and December 2022, totaling 81 ears. During the follow-up period of 1 to 2 years postoperatively, plastic surgeons conducted a comprehensive morphological assessment of the reconstructed ears. Of these, 64 ears (79.0%) were rated as having good morphology, 13 ears (16.0%) as moderate, and 4 ears (4.9%) as poor. A survey on patient satisfaction revealed that 62 patients (82.7%) were satisfied with their reconstructed ears, 11 patients (14.7%) found the results acceptable, and 2 patients (2.7%) deemed them unacceptable. Postoperative complications included infections in 2 ears (2.5%), hematoma in 1 ear (1.2%), cartilage framework exposure in 3 ears (3.7%), and hypertrophic scarring in 5 ears (6.2%). There were no instances of skin flap necrosis, frame deformation, absorption, or wire exposure during the follow-up period.</div></div><div><h3>Conclusions</h3><div>The multilayered three-dimensional costal cartilage auricular framework we constructed for auricular reconstruction with an expanded postauricular skin flap resulted in the majority of reconstructed ears maintaining a satisfactory shape, with clear substructures, lifelike morphology, and strong three-dimensionality. Patient satisfaction with the surgical outcomes was high, achieving good stability and aesthetic effects.</div></div>","PeriodicalId":50084,"journal":{"name":"Journal of Plastic Reconstructive and Aesthetic Surgery","volume":"102 ","pages":"Pages 306-312"},"PeriodicalIF":2.0,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143394982","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The rise of pediatric reduction mammoplasties over the past decade: Trends in patients and surgical outcomes","authors":"Isha Joshi ,&nbsp;Jessica C. El-Mallah ,&nbsp;Andrea R. Hiller ,&nbsp;Alicia C. Greene ,&nbsp;Olivia Waldron ,&nbsp;Evan D. Hicks ,&nbsp;Kevin Schlidt ,&nbsp;Alexis Tashima ,&nbsp;Cathy Henry","doi":"10.1016/j.bjps.2025.01.075","DOIUrl":"10.1016/j.bjps.2025.01.075","url":null,"abstract":"<div><h3>Objectives</h3><div>Symptomatic macromastia can lead to physical and psychosocial challenges, especially in younger patients. Here we aim to assess trends in the volume of pediatric reduction mammoplasties and their associated outcomes.</div></div><div><h3>Methods</h3><div>A retrospective review of the American College of Surgeons National Surgical Quality Improvement Program Pediatric (NSQIP-P) Participant Use Data File identified pediatric patients who underwent reduction mammoplasty from 2012 to 2021. Trends in surgical volume were assessed using annual percent change. Patient characteristics and clinical outcomes were compared using standard univariate statistics. Multivariable analysis was used to model the influence of covariates on surgical volume.</div></div><div><h3>Results</h3><div>2129 patients were identified, with majority being White (48.7%) with a mean age of 16.7 (x±1.1) years. Rates of pediatric reduction mammoplasty increased 1,589.7% from 2012 to 2021. This was observed to be correlated with a significant rise in rate of outpatient surgeries being performed. Patient demographics including age, body mass index, and race were not observed to change over time.</div></div><div><h3>Conclusions</h3><div>There has been a steady increase in pediatric reduction mammoplasties over the past decade irrespective of factors including age and BMI. This is possibly driven by the increasedoccurrence of these procedures being performed in an outpatient setting. These findings underscore the need for ongoing research and awareness to determine additional factors related to evolving patient population.</div></div>","PeriodicalId":50084,"journal":{"name":"Journal of Plastic Reconstructive and Aesthetic Surgery","volume":"102 ","pages":"Pages 228-230"},"PeriodicalIF":2.0,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143388515","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Optimising neurorrhaphy position without compromising flap inset in neurotised abdominal based breast reconstruction","authors":"Apresh A. Singla,&nbsp;Vimal Gokani,&nbsp;Shrada Limbu,&nbsp;Francis P. Henry","doi":"10.1016/j.bjps.2025.01.081","DOIUrl":"10.1016/j.bjps.2025.01.081","url":null,"abstract":"<div><div>Neurotization represents a promising adjunct in the technique of autologous breast reconstruction following mastectomy (1). However, there is a paucity of literature on the actual technique of neurotization and the practicality of selecting donor and recipient nerves when considering pedicle length, perforator position and flap inset plan.</div><div>We describe the neurotization technique in detail which permits a number of flap inset patterns, with no additional donor site morbidity, and minimal extra surgical time. This includes an ideal technique for the selection and harvest of recipient nerves when considering ipsilateral or contralateral flap transfer with 180-degree and 90-degree flap rotation, respectively. The selection of flap sensory branches is from the 10th, 11th, and 12th intercostal nerves. The selection of the dominant perforators, laterality of the nerves, and craniocaudal positioning need to be factored into the decision-making process to obtain sufficient length to achieve a tension free coaptation. Although nerve conduits have been described to compensate for this, this adds a significant additional cost and may affect the regenerative potential due to additional coaptation sites.</div><div>The potential donor nerves are the anterior branch of the 3rd intercostal nerve, including the collateral branch along the superior aspect and the lateral cutaneous branch of the 4th intercostal space.</div><div>We provide a practical discussion and algorithm based on our case series of recipient and donor nerve harvests, as it pertains to breast shaping to achieve a tension-free repair that in turn ensures maximal regeneration across the coaptation site.</div></div>","PeriodicalId":50084,"journal":{"name":"Journal of Plastic Reconstructive and Aesthetic Surgery","volume":"102 ","pages":"Pages 249-254"},"PeriodicalIF":2.0,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143388517","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Proximal interphalangeal joint arthroplasty using self-locking type surface replacement implant for symptomatic osteoarthritis: Extended dorsal central splitting approach and intermediate-term outcome","authors":"Yoshitaka Hamada ,&nbsp;Yoshitaka Minamikawa ,&nbsp;Satoshi Usami ,&nbsp;Takeyasu Toyama ,&nbsp;Masahiro Sawada ,&nbsp;Takanori Saito","doi":"10.1016/j.bjps.2025.01.039","DOIUrl":"10.1016/j.bjps.2025.01.039","url":null,"abstract":"<div><h3>Background</h3><div>This retrospective study introduced wide exposure and radical osteophytectomy by employing the extended dorsal central splitting approach (EDCSA) to mitigate complications associated with surface implant arthroplasty for osteoarthritis of the proximal interphalangeal (PIP) joint using a self-locking type of implant.</div></div><div><h3>Methods</h3><div>In total, 171 fingers of 113 patients underwent cementless surface non-constrained PIP implantation using the EDCSA. The surgical approach involved larger implant placement, optional procedures, and complex collateral ligament repair following wide exposure and thorough shaving of the osteophytes and periarticular bone. Pre- and postoperative outcomes; range of motion; Quick Disabilities of the Arm, Shoulder, and Hand (Q-DASH) scores; subjective pain scores; radiographic findings; and patient satisfaction were assessed.</div></div><div><h3>Results</h3><div>The active range of motion of the PIP joint improved from −18°/58° to −15°/84° (extension/flexion), and remaining stiffness (arc &lt; 40°) was observed in 21 PIP joints (12%) at a mean follow-up of 4.8 years. Patients reported significantly reduced pain and improved Q-DASH scores, with 92% overall patient satisfaction. Radical osteophytectomy effectively prevented recurrence and heterotopic ossification. Complications in the operated fingers occurred in 24.0% of cases, with a reoperation rate of 8.8%, primarily due to soft tissue-related issues. No implant-related symptomatic complications were identified, except for 1 case of dislocation and 1 of mild implant loosening with infection.</div></div><div><h3>Conclusion</h3><div>Self-locking surface replacement implants offer stable fixation without failure in the intermediate term. The EDCSA demonstrated excellent results and advantages, leading to easy identification of each joint structure to facilitate radical osteophytectomy.</div></div>","PeriodicalId":50084,"journal":{"name":"Journal of Plastic Reconstructive and Aesthetic Surgery","volume":"102 ","pages":"Pages 287-292"},"PeriodicalIF":2.0,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143394980","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}